Purpose The cost of malpractice insurance for physicians who provide obstetrical care has been increasing dramatically in recent years. According to the AMA, Washington State is currently one of 20 states in a medical liability crisis, with only 6 states now not in crisis. In response to the current cost of liability insurance, many family practice physicians have simply stopped caring for OB patients. In Washington State, the percentage of doctors providing maternity care declined from 26.1% in 1993 to 22.4% in 2000. This trend is particularly devastating to rural communities, because family practice physicians provide the majority of rural obstetrical care. We hypothesized that the malpractice crisis in Washington is adversely impacting access of rural patients to maternity care.
Methods We asked all of the Family Practitioners, mayors, the Hospital Administrator, Obstetrician and Nurse Midwife within one rural county in Washington State, Kittitas County, to participate in a structured interview to ascertain the effect this crisis has had on them personally and on their communities and to solicit ideas about how this problem can be solved. Twelve out of the fourteen Family Practitioners, four out of five mayors, the Hospital Administrator, Obstetrician, and Nurse Midwife agreed to be interviewed.
Results Malpractice insurance has increased as much as 55% for family physicians doing obstetrics compared to two years ago. Access to OB care in Kittitas County is not a problem currently as there are enough of Obstetrical care providers in the county right now. However, as the cost of malpractice insurance increases disproportionately to reimbursement for medical care, all of the doctors' incomes have decreased and most of them say that this issue has affected their enthusiasm for medicine. They also report that, although this crisis has occurred before, the magnitude this time is bigger and is very near the breaking point. The majority of the interviewed providers and leaders believed that some sort of tort reform could help this problem. Mayors were somewhat aware of the problem, but most were unaware of its severity and most have seen no impact on their communities.
Conclusion Family Practice Physicians in this rural county in Washington State all recognize that the increase in malpractice premiums is a serious problem that threatens to decrease access to obstetrical care in their communities. If something is not done to curb and correct their enormous premiums, many of them plan to quit providing OB care or completely change careers. The study shows that access to OB care in this community is definitely an impending problem.
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